Incidence Rates of Endophthalmitis after Various Pharmaceutical Intravitreal Injections
Main Article Content
Abstract
Introduction: The purpose of this study is to analyze incidence rates of endophthalmitis after intravitreal injection(s) of bevacizumab (BEVA), brolucizumab (BROL), aflibercept (AFL), ranibizumab (RAN), dexamethasone implant (DEXA), and triamcinolone acetonide (TRIA).
Methods: In this retrospective cohort study data was collected from patients who received intravitreal injections from January 2020 through November 2021, of AFL, BEVA, BROL, DEXA, TRIA and RAN. Data collected includes patient identification number, injection dates, medication injected, and procedure codes. Endophthalmitis rates were compared amongst medications and total percentage tabulated.
Result: From January 2020 through November 2021, 109,202 injections were administered. Of the 109,202 injections administered: 66,095 were aflibercept, 28,762 bevacizumab, 8,650 ranibizumab, 3,010 brolucizumab, 1,958 dexamethasone implant, and 95 triamcinolone acetonide. Thirty-nine (0.036%) endophthalmitis cases occurred. Of the 39 endophthalmitis cases, 22 of the cases occurred (0.033% of total aflibercept injections) after aflibercept injection(s), 5 (0.688% of total triamcinolone acetonide injections) after triamcinolone acetonide injection(s), 5 (0.03% of total bevacizumab injections) after bevacizumab injection(s), 3 (0.153% of total dexamethasone implants) after dexamethasone implantation(s), 2 (0.066% of total brolucizumab injections) after brolucizumab injection(s), 2 (0.023% of total ranibizumab injections) after ranibizumab injection(s).(Table 1) Using a student’s t-test, the rate of endophthalmitis for TRIA versus all other medications was statistically significant with a p-value of 0.00152.
Conclusion: Results show an endophthalmitis incidence rate of 0.036% after intravitreal injection(s) administration. This review suggests triamcinolone acetonide (TRIA) yielded a significantly higher incidence rate of endophthalmitis as compared to the other medications.
Keywords
Endophthalmitis, Intravitreal Injection, Retina, Ophthalmology
Article Details
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References
2.) Torres-Costa S, Ramos D, Brandão E, Carneiro Â, Rosas V, Rocha-Sousa A, Falcão-Reis F, Falcão M. Incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis. Eur J Ophthalmol. 2021 Mar;31(2):600-606. doi: 10.1177/1120672120902028. Epub 2020 Feb 4.
3.) Durand ML. Endophthalmitis. Clin Microbiol Infect. 2013 Mar;19(3):227-34. doi: 10.1111/1469-0691.12118.
4.) Mishra C, Lalitha P, Rameshkumar G, et al. Incidence of endophthalmitis after intravitreal injections: risk factors, microbiology profile, and clinical outcomes. Ocul Immunol Inflamm. 2018;26(4):559-568.
5.) Moshfeghi DM, Kaiser PK, Scott IU, Sears JE, Benz M, Sinesterra JP, Kaiser RS, Bakri SJ, Maturi RK, Belmont J, Beer PM, Murray TG, Quiroz-Mercado H, Mieler WF. Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol. 2003 Nov;136(5):791-6. doi: 10.1016/s0002-9394(03)00483-5.
6.) Ozkiriş A, Erkiliç K. Complications of intravitreal injection of triamcinolone acetonide. Can J Ophthalmol. 2005 Feb;40(1):63-8. doi: 10.1016/S0008-4182(05)80119-X.
7.) Storey PP, Tauqeer Z, Yonekawa Y, et. al; Post-Injection Endophthalmitis (PIE) Study Group. The Impact of Prefilled Syringes on Endophthalmitis Following Intravitreal Injection of Ranibizumab. Am J Ophthalmol. 2019 Mar;199:200-208. doi: 10.1016/j.ajo.2018.11.023. Epub 2018 Dec 13.
8.) Gopal L, Sharma T. Use of intravitreal injection of triamcinolone acetonide in the treatment of age-related macular degeneration. Indian J Ophthalmol. 2007 Nov-Dec;55(6):431-5. doi: 10.4103/0301-4738.36477.
9.) Wang YS, Friedrichs U, Eicler W, Hoffmann S, Wiedemann P. Inhibitory effects of triamcinolone acetonide on bFGF- induced migration and tube formation in choroidal microvascular endothelial cells. Graefes Arch Clin Exp Ophthalmol. 2002;240:42–8.
10.) Tufan HA, Vural A, Gencer B, Kara S, Arikan S & Yuksel E (2013): Bacterial contamination of needles used for intravitreal injections: comparison between 27-gauge and 30-gauge needles. Ocul Immunol Inflamm 21: 366–370.
11.) lyse Kornblau, Hamza Pasha, Clark Andersen, Jaafar El-Annan; Does size really matter? Comparing rates of endophthalmitis following intravitreal injections using 30 vs. 32 gauge needles. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6183.